In general, wound healing is a positive physiological reaction that may restore anatomy and function of various tissues after trauma. The trauma may be accidental, the result of surgical intervention or the effect of a disease or genetic condition. The ideal end result of wound healing should be to restore the tissues to the situation before the trauma. One important part of the wound healing process is to form connective tissues or scar tissue that may support the healing tissues during wound healing and regeneration. However, in many cases during wound healing, the newly formed connective tissues (scar tissue) may interfere negatively with the normal function of the healing tissues. The wound healing with formation of new connective tissues may also induce adhesions that may induce pathological conditions per se. Adhesions and scarring may also reduce the possibilities of later surgical intervention of the injured tissue if needed. Scar tissue may also induce cosmetically undesirable results such as cheloid formation. Examples of adhesions and scarring may be found virtually in any organ or tissue undergoing wound healing after trauma or surgery. Following abdominal surgery and following gynecological surgery it is not uncommon that the surgical procedure per se may induce adhesions that may both make later surgery more difficult and even induce pathological conditions such as ileus. Following spinal surgery it is common to have a situation with a dense scar formation called epidural fibrosis. This may in certain case induce significant difficulties for repeated surgery and has also been suggested to induce compression of the adjacent nerve tissue. In other organs excessive wound healing may induce unwanted fixation of tissues and structures that may reduce function and induce pathological conditions. In general, a method for controlling the wound healing, particularly the formation of scar tissue and adhesions, would be of a great value in most cases of posttraumatic or post surgical wound healing.
In the literature it is has been recognized that foetal tissues heal with emphasis of regeneration of the injured tissue with no or little scar formation. In contrast, adult tissues instead may result in scar formation that may dominate over tissue regeneration. The fibroblasts that invade the area of wound healing have been suggested to play a key role in scar formation since they are the cells that are responsible for the formation of collagen, which is the main constituent of a scar. The fibroblasts should also play a key role in adhesion formation since the main component of adhesions is collagen formed by fibroblasts.
Since the fibroblasts are responsible for producing collagen attention has been drawn to the regulation of the fibroblasts in order to reduce scar formation. Transforming growth factor (TGF), which is an anti-inflammatory cytokine, and fibroblast growth factor (FGF) are known to stimulate the fibroblasts to produce collagen. Attempts have been made to administer a TGF-inhibitor for this purpose with varying degree of success. Tumor necrosis factor alpha (TNF) and interleukin 1 (IL-1) may reduce collagen production from fibroblasts in in vitro systems. However, no attempts have been made to reduce scar formation by administration of these two cytokines.